The repair of simple cardiac malformations under extracorporeal circulation is already quite safe and the mortality rate is close to zero. Recently, people are more concerned about the cosmetic impact of surgery, so there is a higher demand for surgery on the cutting day, and small incision surgery has emerged. Many units in China have already carried out intracardiac surgery without aortic blockage in extracorporeal circulation, with a beating heart or hypothermic ventricular fibrillation [5]. The authors applied the technique of non-blocked aorta in small-incision cardiac surgery, with a view to simplifying the procedure and achieving microtrauma and cosmetic results, while ensuring surgical safety. Clinical data From August 1998 to June 1999, 72 pediatric cases underwent intracardiac malformation repair in our department using the following methods. Among them, 40 were male and 32 were female. The average age was 4.5 years (July-12 years), and the average weight was 15.6 kg (7-30 kg). 56 ventricular septal defects, of which 32 were membranous septal defects, 16 were perimembranous defects, and 8 were subdural defects, with an average defect diameter of 7.1 mm (3-15 mm), 11 were patch repairs, and the rest were direct sutures. 16 ventricular septal defects, of which 2 were primary foramen ovale defects combined with incomplete closure of the first cusp valve, 4 were patch repairs, and the rest were direct sutures. The rest were sutured. Surgical technique A median skin incision was made from the upper edge of the flat second rib cartilage below the sternal angle to the junction of the glabella and sternum, approximately 4-8 c in length (depending on weight). The sternal process is turned upward and excised or preserved. The body of the sternum is sawed medially, leaving the sternal stalk intact. Cut one side of the sternum diagonally upward at one intercostal space (unnecessary in children under 4 years of age). A small spreader is used to open the sternum, and the pericardium is incised and sutured with a pericardial traction line. The assistant should pull the sternal stalk upward with a small pull hook to better expose the ascending aorta, and suture the aortic perfusion tube with sutures and cannula. The upper and lower vena cava are cannulated and drained in a conventional manner. The machine is connected to divert the flow and maintain a certain perfusion pressure. For simple malformations, only the upper and lower vena cava is blocked without lowering the temperature, and the aorta is not blocked. Under the beating heart, the repair is performed through the right atrium or right ventricular cut day, which helps to fully reveal the malformation by suctioning the field, but the left heart must not be suctioned. In patients who require patch repair of the defect, it is advisable to lower the temperature appropriately and perform the malformation repair in ventricular fibrillation. Pay attention to the conduction bundle course and the position of the by-pass artery valve, which must not be damaged. The knot should be tied with even force and not against the contracting myocardium to prevent tearing. Adequate venting should be performed before closing the left heart. When closing the sternum, note that the broken ends should be as close together as possible. Results All children were cured. The average skin cut day length was 6. 8 cm ( 4 to 8 cm}. The mean diversion time was (21sh20) min (8-58 min); the mean operative time was (2. 1sh0. 4) h (1. 1- 2. 5 h). The average postoperative hospital stay was 4.2 d ( 3-6 d). o There were no complications such as respiratory insufficiency, incisional infection, conduction block and residual shunt and hemorrhage. No deformation or infection of the thorax was observed in the children at 1-8 months of follow-up. The conventional median sternal incision is the most commonly used incision for open heart surgery and provides good visualization of all parts of the heart and the beginning of the great vessels. However, it has the disadvantage of leaving a large permanent scar, which causes long-term psychological stress to the patient, especially for young women. To overcome this disadvantage, our department has developed small incision surgery. The small incision sternotomy has been used abroad to establish extracorporeal circulation under the blocked aorta for intracardiac malformation repair, and it has been included in the category of minimally invasive cardiac surgery. The cases were mainly atrial and ventricular defects in infants and children. The results are quite satisfactory. However, this method has certain disadvantages, such as poor exposure of the ascending aorta due to the small incision, and difficulties in aortic cannulation and clamping blocking forceps. This modified technique is characterized by the following points: the longitudinal part of the sternum is sawed without transection (under 5 years old), or only one side is cut obliquely, so that the postoperative sternum is stable and the postoperative pain is light. The middle artery is not blocked, myocardial perfusion is adequate, and there is no severe myocardial ischemia and ischemia-reperfusion injury. There is no need to insert aortic cold perfusion needle and clip aortic blocking forceps, which simplifies the operation and speeds up the operation.4 In the event of an intraoperative accident, the incision can be quickly changed to a conventional incision, and no additional injury is added. Many units in China have carried out the correction of intracardiac malformations without blocking the aorta, non-stop beating of the heart or cryo-induced fibrillation. The advantage is that it does not cause severe myocardial ischemia and can prevent reperfusion injury. At the same time, several experiences have shown that without blocking the aorta, air embolism complications do not occur as long as adequate venting is observed. However, it is relatively difficult to expose intracardiac malformations because the heart is in a beating state, with the coronary sinus orifice returning blood and the defective orifice surging blood. Therefore, a clear preoperative diagnosis, clear anatomy of the operator, and tacit cooperation of the assistant are required. The present results suggest that simple cardiac malformation surgery using a modified small incision technique can shorten the operative time, reduce postoperative pain and respiratory insufficiency, promote early postoperative recovery, shorten postoperative hospital days, and reduce the cosmetic damage of surgical scars.